Tse Ka Yu, Ushijima Kimio, Tan Ai Ling, Intasorn Perapong, Pariyar Jitendra, Chang Chih-Long, Domingo Efren J, Konar Hiralal, Kumarasamy Suresh, Tjokroprawiro Brahmana Askandar, Wilailak Sarikapan
Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, Hong Kong.
Department of Obstetrics and Gynaecology, Kurume University, Kurume, Japan.
J Obstet Gynaecol Res. 2023 Apr;49(4):1230-1243. doi: 10.1111/jog.15566. Epub 2023 Feb 1.
Despite the introduction of cervical cancer screening and human papillomavirus (HPV) vaccines, the utilization pattern was not standardized. The aim of this study was to elicit the current prevention care in Asia-Oceania.
An online questionnaire was circulated to different countries/cities in Asia-Oceania. The primary objective was to evaluate the coverage of HPV vaccination and cervical screening programs. The secondary objectives were to study the structures of these programs. Five case scenarios were set to understand how the respondents manage the abnormal screening results.
Fourteen respondents from 10 countries/cities had participated. Cervical cancer ranked the first in Myanmar and Nepal. About 10%-15% did not have national vaccination or screening program. The estimated coverage rate for vaccination and screening varied from less than 1% to 70%, which the coverage ran in parallel with the incidence and mortality rates of cervical cancer. All regions approved HPV vaccines, although only four provided free or subsidized programs for nonavalent vaccine. Cervical cytology remained the most common screening tool, and 20%-30% relied heavily on visual inspection using acetic acid. The screening age groups varied in different regions. From the case scenarios, it was noted that some respondents tended to offer more frequent screening tests or colposcopy than recommended by international guidelines.
This study revealed discrepancy in the practice of cervical cancer prevention in Asia-Oceania especially access to HPV vaccines. There is an urgent need for a global collaboration to eliminate cervical cancer by public education, reforming services, and medical training.
尽管引入了宫颈癌筛查和人乳头瘤病毒（HPV）疫苗，但使用模式并不规范。本研究的目的是了解亚太地区目前的预防保健情况。
向亚太地区不同国家/城市发放了一份在线问卷。主要目的是评估HPV疫苗接种和宫颈癌筛查项目的覆盖情况。次要目的是研究这些项目的结构。设置了五个案例场景，以了解受访者如何处理异常筛查结果。
来自10个国家/城市的14名受访者参与了调查。在缅甸和尼泊尔，宫颈癌位居首位。约10%-15%的地区没有国家疫苗接种或筛查项目。疫苗接种和筛查的估计覆盖率从不到1%到70%不等，其覆盖率与宫颈癌的发病率和死亡率平行。所有地区都批准了HPV疫苗，尽管只有四个地区为九价疫苗提供免费或补贴项目。宫颈细胞学检查仍然是最常见的筛查工具，20%-30%的地区严重依赖醋酸肉眼观察。不同地区的筛查年龄组有所不同。从案例场景中可以看出，一些受访者倾向于提供比国际指南建议更频繁的筛查测试或阴道镜检查。
本研究揭示了亚太地区在宫颈癌预防实践中的差异，尤其是在HPV疫苗接种方面。迫切需要通过公众教育、改革服务和医学培训进行全球合作以消除宫颈癌。
